Condition Overview
Managing thyroid nodules is what we do all day, everyday, at the Russell Center. Thyroid nodules are lumps or growths within the thyroid gland, which is located at the base of the neck. They are relatively common, particularly in older adults (up to 80% of older adults in North American have a thyroid nodule!), and can be either benign (non-cancerous) or malignant (cancerous). Most thyroid nodules are benign, with only a small percentage (5-15%) being malignant. They can vary in size from very small to quite large, and may be solid or filled with fluid (cystic).
Patients with thyroid nodules are often asymptomatic, and the nodules are frequently discovered incidentally during routine physical exams or imaging studies performed for other reasons. When symptoms do occur, they may include a palpable lump in the neck, difficulty swallowing (dysphagia), difficulty breathing (dyspnea), hoarseness, and sometimes pain. Large nodules can cause visible swelling in the neck. Sometimes, nodules can be overactive and cause symptoms due to too much thyroid hormone.
Diagnosis of thyroid nodules involves a combination of physical examination, ultrasound imaging, and fine-needle aspiration biopsy (FNAB) to determine the nature of the nodule. Blood tests to measure thyroid function, such as TSH, T3, and T4 levels, can help assess whether the nodule is associated with abnormal thyroid function.
Treatment of thyroid nodules is usually not required unless a patient has symptoms or has a growing nodule. When a patient has symptoms, we try to match the level of the symptoms to the desired treatment. In other words, if the symptoms are mild we may recommend a less involved treatment. When symptoms are more severe, we try to manage those symptoms as best we can while being as definitive as safely possible. In all things, the goals of the patient drive our decision making process.
Treatment Options
- Active Surveillance
- Description: Active surveillance involves regular monitoring of the thyroid nodule with periodic ultrasound examinations and clinical evaluations. This approach is suitable for benign nodules that are asymptomatic and not growing, or small thyroid cancers in a good location. To be eligible for active surveillance (non-operative surveillance), it is critical that you have excellent follow up. It could be dangerous to leave a cancer in your neck if you are unable to get regular ultrasounds, and so we will insist on making sure that you have an endocrinologist who will be following your regularly with ultrasounds and is comfortable with non-operative management.
- Indications: Asymptomatic benign nodules, patient preference to avoid surgery, low-risk nodules, nodules without suspicious features.
- Radiofrequency Ablation (RFA)
- Description: RFA is a minimally invasive procedure that uses heat generated by radiofrequency energy to destroy nodule tissue. It can reduce the size of benign nodules and alleviate symptoms without the need for surgery. It can be used for small thyroid cancers, but is especially effective for symptomatic benign thyroid nodules.
- Indications: Symptomatic benign nodules, patients seeking non-surgical treatment, nodules causing compressive symptoms.
- Thyroid Lobectomy (hemithyroidectomy)
- Description: This surgical procedure involves the removal of one lobe of the thyroid gland (each side of the thyroid is called a "lobe," and can be thought of as a butterfly wing). Hemithyroidectomy is often recommended for nodules with indeterminate biopsy results or those that cause symptoms. Removing a thyroid nodule is the only way to know with certainty that it is not cancerous, and so some nodules may require surgery even doctors are not sure that it is cancerous. Fortunately, surgery is usually not needed to safely diagnose a patient. Usually at the Russell Center, we can do thyroid surgery without a scar.
- Partial thyroidectomy is a subset of thyroid lobectomy, and includes removal of only a part of one side of the thyroid. This is rarely safe to do for multiple reasons. Please speak with us if you would like to know more about your specific case.
- Indications: Nodules with suspicious or indeterminate FNAB results, large or symptomatic nodules, patient preference for definitive treatment.
- Total Thyroidectomy
- Description: Total thyroidectomy involves the complete removal of the thyroid gland. It is generally reserved for cases where multiple nodules are present, the nodule is confirmed to be malignant, or there is a high suspicion of large or aggressive cancer. Because there is a risk of permanent hypoparathyroidism after surgery, we try to avoid total removal of the entire thyroid gland unless it is necessary.
- Indications: Confirmed thyroid cancer, multifocal nodules, high-risk nodules, patient preference for comprehensive treatment.
- Ethanol Ablation
- Description: Ethanol ablation involves the injection of ethanol (alcohol) into the nodule to induce shrinkage by causing the cyst walls to collapse. It is an effective treatment for cystic nodules. Ethanol ablation does not work well with solid nodules, very large cystic nodules, or nodules with multiple walls (loculations) within the cyst. BUT, it is a low risk option that can benefit many patients with cystic nodules. Dr Russell has been the primary surgeon offering this technique in the Mid-Atlantic for the last 10 years.
- Indications: Benign cystic nodules, patients seeking minimally invasive treatment, nodules causing compressive symptoms.
The choice of treatment depends on the nodule's characteristics, patient preferences, and overall risk assessment. Regular monitoring and follow-up are essential to detect any changes in the nodule's size or characteristics and to adjust the management plan as needed. Because there are so many treatment options, you deserve to speak with a doctor or surgeon who can offer all of them to you.
